• Innovation in Action

Sep 1, 2021

Antibiotic Stewardship Core Element 5: Tracking and Monitoring Antibiotic Prescribing, Use and Resistance

Antibiotics. Medical Concept with Blured Background.

Core Element 5 of the Antibiotic Stewardship Programs (ASP) series emphasizes efforts to monitor antibiotic prescribing and resistance patterns, which is essential to identify opportunities for improvement and to evaluate the impact of improvement efforts. Systematic collection of this data allows facilities to assess, monitor and improve prescribing practices

Read through the examples of actions to support data collection efforts below to see if your organization is on the right track.

Basic (Process Measures)
1 Adherence to documentation policies, e.g., requirement to document indications for antibiotic use and requirements to document performance of time-outs
2 Tracking diagnosis, drug, dose, duration and de-escalation with antibiotic time-out
3 Adherence to facility specific treatment recommendations and guidelines
4 Adherence to specified interventions
5 Accurate antibiotic allergy and adverse reaction histories
Intermediate (Outcome Measures)
1 Sequential tracking of antibiotic resistance patterns, e.g., gram negative resistance
2 Tracking of C. difficile infection rates
3 30-day readmission rates for pneumonia and C. difficile
Advanced (Antibiotic Use Measures)
1 Number of antibiotics administered to patients per day. Hospitals can use the CDC National Healthcare Safety Network (NHSN) Antibiotic Use Option to track and benchmark days of therapy.
2 Grams of antibiotic used (defined daily dose or “DDD” could be used if days of therapy “DOT” not available)
3 Standardized antibiotic administration ratio (SAAR) available to hospitals enrolled in NHSN Antibiotic Use Option
4 Direct antibiotic expenditures (purchasing costs)

Challenges to data collection could include the ASP team not having resources to conduct measurements, lack of enough isolates to produce an antibiogram, an overwhelming amount of data, lack of expertise for data collection and analysis, lack of IT infrastructure and issues defining “appropriate” or “optimal.” The ASP can be prepared to deal with those obstacles using these solution ideas.

  • Review organisms on the CDC threat report, identify top pathogens relevant to the facility and monitor one or more of those.
  • Consider choosing one measure of antibiotic use.
  • Use shared data to compare with other hospitals.
  • Develop relationships with data experts through state collaboratives, health departments, specialty societies or trade associations.
  • Review antibiotic susceptibility data on a regional basis.
  • Engage units in tracking efforts (e.g., ask each unit to track and report on one syndrome and identified metrics).
  • Partner with quality improvement and infection control staff to explore and identify ways to collaborate for data collection.
  • Ensure that tracking and monitoring are part of discussions with IT staff and facility administration when asking for their support in stewardship efforts.
  • Use facility-specific guidelines as the basis for discussions about appropriate use; disregard complex cases that cannot be assessed easily.
  • Conduct periodic audits of appropriate use to identify targets for improvement.
  • Use standardized audit tools for appropriate use.

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